the all breast cancer report was published in october 2009 breastscreen/research.html#breast-...

The All Breast Cancer Report was

published in

October 2009http://www.cancerscreening.nhs.uk/breastscreen/research.html#breast-cancer-report

Introduction• The ‘All Breast Cancer Report’ brings together information on nearly

50,000 people diagnosed with breast cancer in the UK in 2006. The report analyses the differences in prognosis and clinical outcome for women with breast cancer in relation to route of presentation (i.e. screening or symptomatic), age at diagnosis, tumour characteristics, deprivation status and ethnicity.

• The NHS Breast Screening Programme audit of screen-detected breast cancers and the Breast Cancer Clinical Outcome Measures (BCCOM) Project which audits symptomatic breast cancers are now well established national audits, but never before have the data included in these audits been analysed as a single cohort with screening and symptomatic breast cancers diagnosed in the UK compared directly.

Figure and Table numbers are taken from the ‘All Breast Cancer Report’

Methodology

Data Sources

Table 1: Hierarchy of data sources used to produce the final dataset.

Where did the data come from?

Cancer Registration

data

Hospital Episode Statistics

data

National Strategic Tracing Service

Index of Deprivation

2007

BCCOM validated

data (sympto-

matic)

NHSBSP validated

data (screen-

detected)

Patient demographics

Deprivation

Ethnicity

Tumour characteristics

Therapeutic treatment

Reconstructive surgery

Survival

Data item England Northern Ireland

Scotland Wales

Morphology

Invasive size, invasive grade, nodal status and Nottingham Prognostic Index for invasive cancers

Receptor status

Surgery

Number of operations

Final therapeutic operation type

Sentinel lymph node biopsy

Immediate reconstruction

Radiotherapy *

Chemotherapy *

Survival

Table 2: Data items in each country included in the analyses in the ‘Tumour Characteristics and Treatment’ sections of the report (*Selected English registries only based on data completeness)

Data Quality and Completeness

Data item Number of

cases % UK % England

Deprivation score 41,412 84 100

Ethnicity 28,239 57 68

Surgical treatment (UK) 39,462 80 -

Surgical treatment (invasive cancers) UK 34,891 71 -

*Morphology (UK) 39,261 99 - Surgical treatment (England) 33,717 - 81

Surgical treatment (invasive cancers) England 29,663 - 72

Morphology (England) 33,545

- 81 *Invasive tumour size (England) 25,350 - 85

*Invasive tumour grade (England) 28,462 - 96

*Nodal status (invasive cancers, England) 20,798 - 70

*NPI (invasive cancers, England) 19,832 - 67

*Oestrogen receptor status (invasive cancers, England) 14,330 - 48

*Progesterone receptor status (invasive cancers, England) 10,954 - 37

*HER2 status (invasive cancers, England) 10,487 - 35

*Number of operations (England) 31,145 - 92

Final therapeutic operation (England) 38,198 - 92

Sentinel lymph node biopsy (England) 18,155 - 44

Immediate reconstruction (England) 3,751 - 9

*Radiotherapy (invasive cancers, England) 19,217 - 65

*Chemotherapy (invasive cancers, England) 20,391 - 69

*Hormone therapy (invasive cancers, England) 17,103 - 58

Table 3: Number and proportion of data items with known values *expressed as a proportion of surgically treated invasive cancers (except Number of operations, all cancers)

Data Quality and CompletenessData Item Screen-detected Symptomatic

Age <1% <1%

Ethnicity 28.6% 33.4%

Deprivation <1% <1%

Invasive size 1.1% 21.3%

Invasive grade <1% 5.7%

Nodal status 2.4% 43.8%

Nottingham Prognostic Index 3.8% 48.0%

Surgery 1.1% 11.3%

Radiotherapy 13.4% 53.2%

Chemotherapy 13.7% 45.7%

Hormone therapy 12.6% 57.3%

Table 4: Proportions of unknown data items for screen-detected and symptomatic cancers

Cohort Characteristics

Age Distribution and Presentation Route

0

1000

2000

3000

4000

5000

6000

70000-

24

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90-9

4

95-9

9

100-

104

105-

109

Age at diagnosis (years)

Nu

mb

ers

of

can

cers

Screen-Detected Symptomatic

Figure 1: UK patients diagnosed with breast cancer in 2006

Country Profile and Invasive StatusRegion/Celtic country

Total cases

Population covered (million)

Eastern 4,731 5.66

North West 5,260 6.58

Northern & Yorkshire 5,460 6.76

Oxford 2,138 2.86 South West 6,839 7.02

Thames 8,305 11.84

Trent 4,168 4.99

West Midlands 4,581 5.38

England 41,482 51.09

Northern Ireland 1,019 1.76

Scotland 4,392 5.14 Wales 2,559 2.98

UK 49,452 60.98

Table 5: Total number of breast cancer cases included in each region/Celtic country

Age (years) Invasive (%) Non-invasive (%) Total cases

<50 92 8 9,226

50-70 85 15 25,856

>70 96 4 14,365

Unknown 80 20 5

Total 90 10 49,452

Table 6: Proportion of invasive and non-invasive breast cancers diagnosed in each age group

Deprivation and Presentation Route

0

1000

2000

3000

4000

5000

6000

7000

Quintile 1 Most Deprived

Quintile 2 Quintile 3 Quintile 4 Quintile 5 Most Affluent

Deprivation (ID2007 Quintile)

Nu

mb

er

of

can

cers

dia

gn

osed

Screen-detected Symptomatic

Figure 2: Patients in England diagnosed with breast cancer in 2006

Ethnicity and Presentation Route

0

10

20

30

40

50

60

70

80

90

100

White Asian Black Chinese Mixed Other

Ethnic Group

Pro

po

rtio

n o

f can

cers

dia

gn

osed

(%

)

Screen-detected Symptomatic

Screen-detected Symptomatic Ethnic group No. % No. %

Total cases

White 8,746 33 18,061 67 26,807

Asian 191 31 420 69 611

Black 81 19 347 81 428

Chinese 23 31 51 69 74

Mixed 22 23 75 77 97

Other 72 32 151 68 222

Total 9,135 32 19,104 68 28,239

Table 7: Number and proportion of breast cancers diagnosed in England with known ethnicity in each presentation route

Deprivation and Ethnicity

0

10

20

30

40

50

60


Ethnic Group

Pro

po

rtio

n o

f ca

nce

rs d

iag

no

sed

(%

) Deprived Quintile 2 Quintile 3 Quintile 4 Affluent

Derived from table in ‘All Breast Cancer Report’

TumourCharacteristics

Tumour Size and Grade

Ethnic group Grade 1 Grade 2 Grade 3 Not

applicable Total cases

White 17% 47% 36% 0% 19,982

Asian 14% 41% 44% 0% 470

Black 9% 34% 56% 1% 328

Chinese 11% 48% 41% 0% 54

Mixed 11% 56% 33% 0% 81

Other 12% 50% 38% 0% 164

Unknown 19% 48% 32% 0% 7,383

Total cases 4,968 13,346 10,070 78 28,462

Table 10: Variation in invasive tumour grade with ethnic group in England

Screen-detected Symptomatic Invasive tumour size

No. % No. %

<15mm 5,332 54% 3,373 22%

15-?20mm 2,393 24% 3.981 26%

>20mm-35mm 1,666 17% 5,547 36%

>35mm-50mm 335 3% 1,584 10%

>50mm 129 1% 1,010 7%

Table 9: Variation in invasive tumour size for screen-detected & symptomatic cancers in England

Nodal Status and Receptor Status

Ethnic group Positive Negative Total cases

White 38% 62% 14,627

Asian 43% 57% 308

Black 64% 36% 221

Chinese 29% 71% 35

Mixed 47% 53% 49

Other 48% 52% 115

Unknown 36% 64% 5,443

Total cases 7,922 12,876 20,798

Table 11: Variation in invasive tumour nodal status with ethnic group in England

ER positive

PR positive

HER2 positive Ethnic group

No. % No. % No. %

White 8,681 84% 5,334 68% 1,289 17%

Asian 187 80% 146 71% 41 21%

Black 84 71% 58 57% 21 22%

Chinese 19 86% 14 70% 4 27%

Mixed 26 90% 20 74% 8 33%

Other 65 84% 40 75% 9 16%

Unknown 3,065 87% 1,994 73% 345 13%

Total cases 12,127 7,606 1,717

Table 14: Variation in receptor status with ethnic group in England

Nottingham Prognostic Index and Presentation Route

NPI = 0.2 X Invasive Size (cm) + Grade + Nodes

Groups = Excellent, Good, Moderate 1, Moderate 2, Poor

0

5

10

15

20

25

30

35

40

EPG GPG MPG1 MPG2 PPG

NPI group

Pro

po

rtio

n o

f ca

nce

rs d

iag

no

sed

(%

) Screen-detected Symptomatic


NPI and Ethnicity (all ages)

0

5

10

15

20

25

30

35

40


Ethnic Group

Pro

po

rtio

n o

f can

cers

dia

gn

osed

(%

)



NPI and Deprivation (all ages)

0

5

10

15

20

25

30

Deprived Quintile 2 Quintile 3 Quintile 4 Affluent

Pro

po

rtio

n o

f c

an

ce

rs d

iag

no

se

d (

%)



Surgical Treatment

Surgery and Age at Diagnosis

0

1000

2000

3000

4000

5000

6000

70000-

24

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85-8

9

90-9

4

95-9

9

100-

104

105-

110

Age at diagnosis (years)

Nu

mb

er o

f ca

nce

rs

Without Surgery With Surgery

Figure 4: Patients in UK diagnosed with breast cancer in 2006

Type of Final Operation and Ethnicity

0

10

20

30

40

50

60

70

White Asian Black Chinese Mixed OtherDeprivation (ID2007 Quintile)

Pro

po

rtio

n o

f can

cers

dia

gn

osed

(%

)

Conservation Mastectomy

Derived from data in ‘All Breast Cancer Report’

Type of Final Operation and Deprivation

0

10

20

30

40

50

60

70

Quintile 1 Most Deprived

Quintile 2 Quintile 3 Quintile 4 Quintile 5 Most Affluent


Pro

po

rtio

n o

f can

cers

dia

gn

osed

(%

)

Conservation Mastectomy


Adjuvant Treatment

Radiotherapy and ChemotherapyCohort

With Radiotherapy

recorded Total cases

All breast invasive cancers 66% 16,133

Female 66% 16,030

Male 45% 103

Screen-detected 69% 5,207

Symptomatic 64% 10,926

Aged <50 70% 3,642

Aged 50-70 69% 9,080

Aged >70 53% 3,408

Breast conserving surgery (England only) 82% 6,944

Mastectomy (England only) 45% 5,573

Table 16: Variation with gender, route of presentation and age in the radiotherapy treatment recorded by the six UK regions with the most complete radiotherapy data

Cohort With

Chemotherapy recorded

Total cases

All breast invasive cancers 41% 26,198

Female 41% 26,032

Male 31% 166

Screen-detected 23% 8,563

Symptomatic 49% 17,635

Aged <50 72% 5,729

Aged 50-70 38% 14,857

Aged >70 16% 5,608

Breast conserving surgery (England only) 34% 12,995

Mastectomy (England only) 48% 9,587

Table 18: Variation with gender, route of presentation and age in the chemotherapy treatment recorded by the eight UK regions with the most complete chemotherapy data

Adjuvant Therapy and Ethnicity and Deprivation

Cohort

With Radiotherapy

recorded Total cases

Ethnic group

White 67% 8,990

Asian 69% 174

Black 71% 83

Chinese 58% 24

Mixed 58% 24

Other 81% 27

Unknown 62% 3,195

Deprivation group

Most deprived 67% 1,639

Quintile 2 64% 2,133



Most affluent 66% 3,222

Cohort With

Chemotherapy recorded

Total cases

Ethnic group

White 41% 15,763

Asian 48% 439

Black 65% 327

Chinese 45% 33

Mixed 53% 76

Other 44% 149

Unknown 35% 5,795

Deprivation group

Most deprived 44% 3,204




Most affluent 38% 5,283

Table 17 and Table 19

Survival

1-year and 5-year Relative Survival

Table 20: 1-year and 5-year relative survival for cohorts of breast cancer patients diagnosed in 2006 and 2001/02 (England only)

1-year relative survival (%)


5-year relative survival (%) Cohort

2006 2001/02 2001/02

All breast cancers 95.8 94.6 82.0

Female 95.8 94.6 82.0

Male 94.6 90.9 81.2 Non-invasive 100.4 100.3 100.2

Invasive 95.3 94.0 80.3 Surgically treated 99.7 - -

No surgery recorded 77.0 - -

Invasive breast cancers

Aged <50 98.4 97.7 84.2 Aged 50-70 97.7 96.8 86.0 Aged >70 88.7 87.2 67.6

Age at Diagnosis and 1-year Relative Survival

80

85

90

95

100

<50 50-70 71+

Age at diagnosis

1 y

r re

lati

ve s

urv

ival

(%)

2001/02

2006

Figure 6: Patients in England diagnosed with breast cancer in 2001/02 and 2006

Relative Survival and Presentation Route and NPI




2006 2001/02 2001/02

All invasive breast cancers 95.8 94.6 82.0

Screen-detected 100.2 100.1 97.4

Symptomatic 93.7 93.0 77.6 Aged 50-70 all invasive breast cancers

97.7 96.8 86.0

Aged 50-70 screen-detected 100.1 100.0 96.2

Aged 50-70 symptomatic 95.2 94.9 80.3

Table 21: 1-year and 5-year relative survival rates; breast cancer patients diagnosed in 2006 and 2001/02 (England only)

80

85

90

95

100

EPG GPG MPG1 MPG2 PGP

NPI groups

1 yr

rel

ativ

e su

rviv

al (

%)

Screen-detected

Symptomatic

Figure 7: Variation in 1-year survival with presentation route and NPI (50-70 age group)

Relative Survival, Ethnicity and Deprivation




2006 2001/02 2001/02

All invasive breast cancers 95.3 94.0 80.3

Ethnic group

White 95.7 95.4 80.9

Black 94.1 97.3 79.6

Asian 98.0 96.6 84.2 Other (Chinese, Mixed and other) 96.7 94.5 80.1 Unknown 94.2 91.8 79.3

Deprivation group

Most deprived 92.1 91.8 73.3

Quintile 2 94.1 92.5 77.0

Quintile 3 95.5 93.9 79.6

Quintile 4 96.2 94.9 83.3

Most affluent 97.1 96.1 85.6

Table 22: Variation in 1-year and 5-year relative survival with ethnic group and deprivation quintile for breast cancer patients diagnosed with invasive breast cancer (England only)

Presentation Route, Relative Survival, Ethnicity and Deprivation

80

85

90

95

100

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 5


1 yr

rel

ativ

e su

rviv

al (

%)

Screen-detected

Symptomatic

Most Deprived Most Affluent

Figure 8: Patients in England diagnosed with breast cancer in 2001/02

Presentation Route, Relative Survival and Deprivation

1-year relative survival 2006 (%)

1-year relative survival 2001/02 (%)

5-year relative survival 2001/02 (%)

Cohort Screen-detected

Sympto-matic

Screen-detected

Sympto-matic

Screen-detected

Sympto-matic

All invasive breast cancers

100.1 95.2 100.0 94.9 96.2 80.3

Ethnic group

White 100.0 95.3 100.0 95.6 95.4 79.6

Black 100.8 92.0 97.3 96.5 99.7 78.0

Asian 100.7 96.1 100.5 94.6 93.7 75.7 Other 98.4 95.2 100.7 98.0 100.1 88.9 Unknown 100.1 93.2 100.1 93.8 97.3 81.3 Deprivation group

Most deprived 99.5 91.6 99.5 92.4 92.8 73.2

Quintile 2 100.1 93.1 99.7 95.3 95.1 78.3

Quintile 3 100.0 95.2 99.9 94.9 94.6 80.4

Quintile 4 100.0 95.7 100.2 95.1 97.1 81.1

Most affluent 100.3 96.2 100.6 96.0 99.4 85.4

Table 23: Variation in 1-year and 5-year relative survival with ethnic group, deprivation quintile and route of presentation for breast cancer patients aged 50-70 diagnosed with invasive breast cancer (England only)

the all breast cancer report was published in october 2009 breastscreen/research.html#breast-...

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